Ventricular Fibrillation: Ablation of a Trigger?

We report the case of a patient with recurrent ventricular fibrillation (VF) and no evidence of structural heart disease. VF was consistently initiated by a relatively early-coupled premature ventricular contraction with identical morphology on each occasion. Treatment with antiarrhythmic agents failed to suppress the arrhythmia. Electrophysiologic testing showed high-frequency potential at the earliest activation site, and radiofrequency ablation resulted in abolition of the ventricular ectopy with no further VF recurrence. Suppression of VF arising from focal triggers in patients with frequent ventricular ectopy and normal heart can be achieved with catheter ablation, but further studies are needed to evaluate the prevalence of such a mechanism.     

Rapid progression of hepatocellular carcinoma after Radiofrequency Ablation

AIM:To report the results of radiofrequency ablation (RFA)of hepatocellular carcinoma (HCC) in cirrhotic patients andto describe the treatment related complications (mainly therapid intrahepatic neoplastic progression).METHODS:Eighty-seven consecutive cirrhotic patients with104 HCC (mean diameter 3.9 cm,1.3 SD) were submittedto RFA between January 1998 and June 2003.In all casesRFA was performed with percutaneous approach underultrasound guidance using expandable electrode needles.Treatment efficacy (necrosis and recurrence) was estimatedwith dual phase computed tomography (CT) and alpha-fetoprotein (AFP)level.RESULTS:Complete necrosis rate after single or multipletreatment was 100%,87.7% and 57.1% in HCC smallerthan 3 cm,between 3 and 5 cm and larger than 5 cmrespectively (P=0.02).Seventeen lesions of 88(19.3%)developed local recurrence after complete necrosis during amean follow up of 19.2 mo.There were no treatment-relateddeaths in 130 procedures and major complications occurredin 8 patients (6.1%).In 4 patients,although complete localnecrosis was achieved,we observed rapid intrahepaticneoplastic progression after treatment.Risk factors for rapidneoplastic progression were high preoperative AFP valuesand location of the tumor near segmental portal branches.CONCLUSION:RFA is an effective treatment for hepatocellularcarcinoma smaller than 5 cm with complete necrosis in morethan 80% of lesions.Patients with elevated AFP levels andtumors located near the main portal branch are at risk forrapid neoplastic progression after RFA.Further studies arenecessary to evaluate the incidence and pathogenesis ofthis underestimated complication.     

Prevention of Premant Atrioventricular Block Complication After Radiofrequency Catheter Ablation

Objective To Summarize the experience of preventing the permanent atrioventricular block complication after radiofrequency catheter ablation(RFCA).     

Incidence and Predictors of Adenocarcinoma Following Endoscopic Ablation of Barrett’s Esophagus

Background

The rate and risk factors of recurrent or metachronous adenocarcinoma following endoscopic ablation therapy in patients with Barrett’s esophagus (BE) have not been specifically reported.

Aim

The aim of this study was to determine the incidence and predictors of adenocarcinoma after ablation therapy for BE high-grade dysplasia (HGD) or intramucosal carcinoma (IMC).

Methods

This is a single center, retrospective review of prospectively collected data on consecutive cases of endoscopic ablation for BE. A total of 223 patients with BE (HGD or IMC) were treated by ablation between 1996 and 2011. Primary outcome measures were recurrence and new development of adenocarcinoma after ablation. Recurrence was defined as the presence of adenocarcinoma following the absence of adenocarcinoma in biopsy samples from two consecutive surveillance endoscopies. Logistic regression analysis was performed to assess predictors of adenocarcinoma after ablation.

Results

One hundred and eighty-three patients were included in the final analysis, and 40 patients were excluded: 22 for palliative ablation, eight lost to follow-up, five for residual carcinoma and five for postoperative state. Median follow-up was 39 months. Recurrence or new development of adenocarcinoma was found in 20 patients (11 %) and the median time to recurrence/development of adenocarcinoma was 11.5 months. Independent predictors of recurrent or metachronous adenocarcinoma were hiatal hernia size ≥ 4 cm (odds ratio 3.649, P = 0.0233) and histology (HGD/adenocarcinoma) after first ablation (odds ratio 4.141, P = 0.0065).

Conclusions

Adenocarcinoma after endoscopic therapy for HGD or IMC in BE is associated with large hiatal hernia and histology status after initial ablation therapy.     

High-sensitivity Troponin I and Ablation Effectiveness Quotient after Ablation Index-guided pulmonary vein isolation—markers of arrhythmia recurrence?

Journal of Interventional Cardiac Electrophysiology - To elucidate the electrophysiological predictors of the intramural origins of left ventricular outflow tract-ventricular tachyarrhythmias...     

Detection of Intestinal Metaplasia After Successful Eradication of Barrett’s Esophagus with Radiofrequency Ablation

Background  

Radiofrequency ablation (RFA) is an effective means of eradicating Barrett’s esophagus (BE), both with and without associated dysplasia. Several studies have documented high initial success rates with RFA. However, there is limited data on IM detection rates after eradication.     

Results of Atrial Fibrillation Ablation in Patients With or Without a History of Atrial Flutter

INTRODUCTION There are two kinds of atrial flutter will meet during AF ablation. Left atrial flutter (LAFL) is a known complication of catheter-based therapies of atrial fibrillation (AF). Linear catheter ablation may lead to instances of“gap”within the…     

The “Window” of Slow Pathway Conduction after Ablation and Recurrence of Atrioventricular Nodal Reentrant Tachycardia

Introduction: Slow pathway (SP) conduction often persists following radiofrequency (RF) catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT). An association between persistent SP conduction, as evidenced by discontinuous AV nodal conduction curves, and recurrent tachycardia has not been established. Of note, the segment of the curve attributable to SP conduction (the window of SP conduction) varies. This study examined whether the maximal post-ablation SP conduction window length differs in patients who later have recurrent tachycardia when compared with those who do not recur. Methods and Results: Electrophysiologic study data were compared in two groups who had undergone RF ablation of the SP for typical AVNRT at a single center from 1992–1998. The groups, consisting of seven known recurrences (Group A) and 50 non-recurrences confirmed through a follow-up survey and phone contact (Group B), were similar in gender proportion, age, baseline electrophysiologic data, and number of RF deliveries. Four patients (57%) from Group A and 26 (52%) from Group B exhibited discontinuous AV nodal conduction curves after ablation. The maximum post-ablation window lengths among patients with dual AV nodal physiology varied widely and similarly in the two groups, and the means did not significantly differ (53±47 msec in Group A vs. 36±31 msec in Group B; p=0.36). Conclusion: Persistent SP conduction post-ablation in this series was a common finding not predictive of recurrence. No difference in the maximum SP conduction window post-ablation was evident between recurrences and non-recurrences.